Non.Invasive Ventilation for Adult Acute Respiratory Failure. Part II.

OBJECTIVE To discuss the clinical indications and complications of non-invasive ventilation. DATA SOURCES A review of articles published in peer-reviewed journals from 1966 to 1998 and identified through a MEDLINE search on non-invasive ventilation. SUMMARY OF REVIEW Non-invasive ventilation (NIV) has been used in patients with respiratory failure caused by cardiogenic pulmonary oedema, acute respiratory distress syndrome, acute asthma and chronic obstructive pulmonary disease. However, in patients with acute respiratory failure, it appears that acute cardiogenic pulmonary oedema and acute respiratory failure associated with Pneumocystis carinii pneumonia are the only disorders in which significant benefits have been associated with the use of the NIV mode of CPAP. The potential clinical benefit of CPAP in acute asthma and blunt chest trauma remains unclear. Pressure support ventilation is beneficial in patients with hypercapnic acute respiratory failure (ARF) secondary to respiratory muscle insufficiency, high inspiratory work loads, or reduced alveolar ventilation. It appears also to be associated with an improved outcome in COPD patients with hypercapnic ARF. CONCLUSIONS Non-invasive ventilation using the modes of CPAP, PSV, BiPAP and NIPPV should be considered in patients with respiratory disorders who remain in acute respiratory failure despite conventional therapy, before considering invasive mechanical ventilation.